它忽視了大部分骨質疏鬆症干預的結果，包括雷奈酸鍶（strontium ranelate） (Kanis JA 2011)，雷洛昔芬（raloxifene） (Kanis JA 2009, Kanis JA 2010)，巴西多昔芬（bazedoxifene）(Kanis JA 2009)，（clodronate）氯磷酸鹽(McCloskey EV 2009)，每日和每週的特立帕肽（teriparatide） (Harvey NC 2015a, Harvey NC 2015b)，阿伐他汀（abaloparatide） (McCloskey EV 2017)，denosumab (McCloskey EV 2012)，阿崙磷酸鈉（alendronate）(DonaldsonMG 2012)以及英國全科醫生使用的治療干預措施(Shepstone L 2017)。

其中大多數是事後分析（post hoc），只有在狄諾塞麥（denosumab）的情況下，是預先計劃的分析（pre-planned analysis）。

此外，老年女性預防骨折（SCOOP）研究的B期篩查是一項前瞻性隨機研究，該研究證實了使用FRAX評估髖骨骨折概率的基礎上選擇的女性髖部骨折的療效(Shepstone L 2017)。

不同的干預閾值會識別處於不同風險的不同患者是不言而喻（axiomatic）的。

一些基於2005 - 2008年全國健康和營養調查（NHANES）(Dawson-Hughes B 2012, Kanis JA 2015)的例子。

令人感興趣的是，ACP指南選擇了比年齡特異性FRAX閾值更大數量的符合治療條件的患者，但後者確定了風險更高的人群。

小魏醫師總結，世界衛生組織的骨折風險評估問卷（FRAX）可以估算每個人未來10年的骨質疏鬆症相關骨折的風險（包含脊椎骨折、前臂骨折、髖骨骨折或肩部骨折）以及髖骨骨折率，以提供預防和治療上的參考。進一步防止嚴重骨質疏鬆症所造成之骨折及其併發症。現在基層醫師更應以此工具當成篩檢骨質疏鬆症的首要工具，甚至不需DXA的BMD值。一旦篩檢結果接近治療閥值，才需進一步檢測骨質密度。這背離ACP（美國醫師學會）的建議，但是卻是其他各國臨床指引及SPR（葡萄牙風濕病學會）、US NOF（美國國家骨質疏鬆症基金會）和AACE（美國臨床內分泌學家協會）的建議方式。

【參考資料】

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